经会阴及经直肠前列腺穿刺活检术的临床应用分析

目的:比较经直肠及经会阴两种前列腺穿刺活检术的阳性率及并发症。方法:回顾性分析2009年1月至2014年1月间156例前列腺穿刺活检病例,其中经直肠径路97例,经会阴径路59例。结果:经直肠径路组穿刺阳性率为48.4%,经会阴径路组为44.1%。根据不同的PSA水平分层,两种径路穿刺活检的阳性率无显著性差异(P0.05)。穿刺后经直肠径路组与经会阴径路组血尿发生率分别为54.6%、42.4%,尿频尿急尿痛发生率分别为17.5%、22.0%,排尿困难发生率分别为9.3%、6.8%,急性尿潴留发生率分别为7.2%、6.8%,上述并发症发生率在两组间差异无统计学意义(P0.05);发热发生率分别为15.5%、3.4%,血便发生率分别为50.5%、3.4%,经直肠径路组要显著高于经会阴径路组(P0.05及P0.01);会阴肿胀发生率分别为3.1%、13.6%,经会阴径路组显著性增高(P0.05)。结论:超声引导下经直肠和经会阴前列腺穿刺活检术都是诊断前列腺癌的有效方法。两种方式的穿刺阳性率无显著性差异,但并发症发生率各有特点,具体方式选择应根据患者情况决定。     

经会阴前列腺穿刺与经直肠前列腺穿刺活检在前列腺癌诊断的初探

目的 对比经会阴与经直肠前列腺穿刺活检在前列腺癌诊断中的阳性率及并发症。方法 回顾分析2017年1月到2019年12月行前列腺穿刺活检的病例,经直肠组187例,经会阴组68例。结果 经直肠组阳性穿刺率为34.7%,经会阴组阳性穿刺率为29.4%,两组无统计学差异（P>0.05）。穿刺后经直肠组和经会阴组的血尿发生率分别为40.1%、42.6%,尿潴留发生率分别为6.9%、7.3%,直肠出血发生率分别为1.1%、0%,差别无统计学意义（P>0.05）。穿刺后经直肠组和经会阴组的会阴肿胀的发生率分别为2.6%、13.2%,两组有统计学差异（P<0.05）。结论 超声引导下经直肠、经会阴前列腺穿刺活检均为前列腺癌诊断的有效方法。两者穿刺阳性率无明显差异,但并发症各有特点。     

超声引导下经直肠与经会阴途径前列腺穿刺活检术的比较

目的比较超声引导下经直肠与经会阴途径前列腺穿刺活检术在前列腺癌诊断中的效果。方法我院2015年12月~2018年12月超声引导下前列腺穿刺319例,其中经直肠162例(经直肠组),经会阴157例(经会阴组),比较2种穿刺活检方法阳性率、并发症发生率。结果经直肠与经会阴途径穿刺阳性率分别为31.5%(51/162)、35.7%(56/157),差异无统计学意义(χ^2=0.765,P=0.382)。2组穿刺后血尿、尿潴留、血管迷走神经反射发生率均无统计学意义(P>0.05)。经直肠组血便发生率14.2%(23/162),明显高于经会阴组1.9%(3/157)(χ^2=16.078,P=0.000);发热发生率9.9%(16/162),明显高于经会阴组2.5%(4/157)(χ^2=7.287,P=0.007);疼痛发生率3.7%(6/162),明显低于经会阴组10.2%(16/157)(χ^2=5.226,P=0.022)。结论直肠超声引导下经直肠与经会阴前列腺穿刺均为检测前列腺癌的有效途径,2种穿刺方法的阳性率相近,经会阴途径血便、发热发生率明显低于经直肠途径,疼痛发生率明显高于经直肠途径,应根据患者具体病情选择合理的穿刺方式。     

模板定位下经会阴前列腺穿刺活检在经直肠途径初次活检阴性患者检查中的应用

目的 探讨模板定位下经会阴前列腺穿刺活检术在对经直肠前列腺穿刺活检阴性患者检查中的有效性及安全性.方法 收集2010年1月至2012年1月经直肠前列腺穿刺活检阴性患者42例.年龄50 ～81岁,平均67岁.PSA 0.9 ～27.3 μg/L,平均13.1 μg/L.入组条件:曾行前列腺穿刺活检≥1次,结果为阴性或前列腺上皮内瘤(PIN)或非典型小细胞腺泡样增生(AAH),但术后tPSA仍＞10 μg/L和(或)PSA速率仍＞0.75 μg/L.取膀胱截石位,会阴部皮下及前列腺尖部包膜浸润麻醉下,行经直肠超声引导下模板定位经会阴前列腺穿刺活检术.分析模板定位下经会阴前列腺穿刺活检术的阳性率、影响因素及并发症.结果 本组行前列腺穿刺16 ～ 44针,平均18.7针.穿刺阳性率为44％ (19/42),Gleason评分4～9分,平均6分.穿刺阳性者前列腺体积27～67 ml,平均44 ml;阴性者37 ～104 ml,平均71 ml,两组比较差异有统计学意义(P＜0.05).穿刺阳性率与患者是否为PIN和AHH、前列腺穿刺针数、PSA值无相关性(P＞0.05).穿刺阳性者前列腺癌在移行区的发生率为74％(14/19),其中36％(5/14)只发生在移行区.穿刺后1周内血尿发生率为29％(12/42),尿潴留发生率为9％ (4/42),无严重感染等并发症发生.结论 模板定位下经会阴前列腺穿刺活检术诊断经直肠途径初次活检阴性患者安全、有效.     

经会阴前列腺24针饱和穿刺活检与14针活检在PSA＜20μg/L患者中筛检前列腺癌的对比性研究

目的:探讨超声引导下经会阴前列腺24针饱和穿刺活检与14针穿刺活检方案对PSA＜20 μg/L可疑前列腺癌患者的筛检阳性率及其相关并发症.方法:选取116例可疑前列腺癌患者行经会阴超声引导下14针穿刺活检(14针组),另136例患者,行经会阴24针饱和前列腺穿刺活检(24针饱和组),比较两组前列腺癌筛检阳性率、标本阳性率及穿刺后肉眼血尿、泌尿系感染、尿潴留等并发症的发生率.结果:两组患者平均年龄、穿刺前PSA水平、平均前列腺体积等指标均无统计学差异(P＞0.05).24针饱和组及14针组前列腺癌筛检总体阳性率分别为48.53％和17.24％,存在显著性差异(P＜0.001),标本阳性率分别为8.09％和2.83％ (P =0.012);其中24针饱和组前列腺尖部肿瘤的检出率(11.76％)显著高于14针组(1.72％,P＜0.05).两组穿刺后尿潴留、泌尿系感染和肉眼血尿等发生率均无统计学差异(P＞0.05).结论:24针经会阴前列腺饱和穿刺活检方法显著提高PSA＜20 μg/L患者中前列腺癌的筛检阳性率,尤其是增加了前列腺尖部区域的肿瘤筛检阳性率,而并未增加相关并发症.     

直肠超声引导下经直肠与经会阴前列腺穿刺活检术的临床分析

目的:评估在直肠超声引导下经直肠与经会阴2种途径行前列腺穿刺活检术在前列腺癌(PCa)检出率以及围手术期并发症等方面的差异。方法:回顾性分析2014年10月～2017年10月我院因PCa待排就诊并符合纳入标准的255例患者的临床资料,所有患者符合前列腺穿刺活检指征。本研究分为两组,2014年10月～2016年5月130例患者接受经直肠前列腺穿刺活检术(经直肠组),2016年6月～2017年10月125例患者接受经会阴前列腺穿刺活检术(经会阴组)。所有患者首次穿刺活检均为系统性穿刺12针,本研究排除了穿刺不同针数的病例以减少偏差,综合分析2种穿刺活检方式的各种指标,包括患者年龄、总PSA(tPSA)、游离PSA(fPSA)、DRE/TRUS检查结果、PCa检出率以及并发症等围手术期各项指标。结果:255例PCa待排患者中,经过病理结果确认,经直肠组诊断为PCa的患者为43.85%(57/130),经会阴组诊断为PCa的患者为50.40%(63/125),两组比较差异无统计学意义。分层分析发现,经会阴组Gleason评分≥7分PCa检出率明显高于经直肠组,在PSA4ng/ml、f/t≥0.15、TRUS检查阴性的患者中,经会阴组的PCa检出率明显高于经直肠组,而在PSA≥4ng/ml、f/t0.15、TRUS检查阳性的患者中经直肠组明显高于经会阴组;在DRE异常的患者中,经会阴组的PCa检出率明显高于经直肠组。经直肠组手术时间为(10.15±3.06)min,经会阴组手术时间为(11.27±0.15)min,两组比较差异无统计学意义;经直肠组和经会阴组术后患者出现肉眼血尿的比例分别为6.92%(9/130)和19.20%(24/125),经直肠组和经会阴组出现尿潴留的比例分别为3.85%(5/130)和17.60%(22/125),两组比较差异均有统计学意义(P0.05);经直肠组和经会阴组直肠出血发生率分别为24.62%(32/130)和0,两组比较差异有统计学意义(P0.05);经直肠组和经会阴组术后感染发生率分别为14.62%(17/130)和1.60%(2/125),两组比较差异有统计学意义(P0.05);经直肠组和经会阴组视觉模拟评分(VAS)分别为(1.17±0.19)分和(2.07±1.08)分,两组比较差异无统计学意义。结论:在经直肠超声引导下不论是经直肠前列腺穿刺活检术还是经会阴前列腺穿刺活检术,在临床上都是安全可行的。经会阴前列腺穿刺活检术在低度可疑PCa检出率方面具有更多优势,具有术后并发症更少等优点,在临床中值得进一步推广。     

经会阴10点以下或以上前列腺活检诊断效率和并发症比较

目的 分析经会阴<10点与≥10点前列腺活检的诊断效率和并发症情况. 方法 经直肠超声引导下经会阴前列腺穿刺活检900例,分2组,<10点组759例(A组),平均活检8点;≥10点组141例(B组),平均活检12点.分析2组间总活检阳性率、PSA分层活检阳性率和并发症的差异. 结果 A、B组前列腺癌检出总阳性率分别为41.6%(316/759)和51.8%(73/141),PSA≤10.0 ng/ml患者中活检阳性率分别为6.8%(16/235)和17.8%(8/45),2组比较差异有统计学意义(P<0.05).并发症发生情况:A组出现肉眼血尿者274例(36.1%),尿潴留2例;B组肉眼血尿53例(37.6%),尿潴留1例,2组并发症比较差异无统计学意义(P>0.05). 结论 ≥10点前列腺活检的诊断效率高于<10点,并发症发生率无明显差异.     

9+X法直肠超声引导下经会阴前列腺穿刺活检420例分析

目的:探讨9+X法经直肠超声引导下经会阴前列腺穿刺活检术诊断前列腺癌的临床价值及安全性。方法:回顾性分析2004年1月至2008年12月行9+X法经直肠超声引导下经会阴前列腺穿刺活检术的可疑前列腺癌患者420例临床资料。结果:穿刺确诊前列腺癌160例(阳性率38.1%)。PSA<4μg/L、4～10μg/L、>10μg/L、直肠指检(DRE)异常、经直肠或经腹部超声检查有异常者阳性率分别为7.4%、17.8%、65.4%、25.0%、22.2%。穿刺术后79例出现血尿(18.8%),急性尿潴留13例(3.1%),发热9例(2.1%),无其他严重并发症。结论:9+X法经直肠超声引导下经会阴前列腺穿刺阳性率高,并发症少,是诊断前列腺癌的理想方法。     

经会阴前列腺24针饱和穿刺活检与14针活检在PSA＜20μg/L患者中筛检前列腺癌的对比性研究

目的:探讨超声引导下经会阴前列腺24针饱和穿刺活检与14针穿刺活检方案对PSA<20μg/L可疑前列腺癌患者的筛检阳性率及其相关并发症。方法:选取116例可疑前列腺癌患者行经会阴超声引导下14针穿刺活检(14针组),另136例患者,行经会阴24针饱和前列腺穿刺活检(24针饱和组),比较两组前列腺癌筛检阳性率、标本阳性率及穿刺后肉眼血尿、泌尿系感染、尿潴留等并发症的发生率。结果:两组患者平均年龄、穿刺前PSA水平、平均前列腺体积等指标均无统计学差异(P>0.05)。24针饱和组及14针组前列腺癌筛检总体阳性率分别为48.53%和17.24%,存在显著性差异(P<0.001),标本阳性率分别为8.09%和2.83%(P=0.012);其中24针饱和组前列腺尖部肿瘤的检出率(11.76%)显著高于14针组(1.72%,P<0.05)。两组穿刺后尿潴留、泌尿系感染和肉眼血尿等发生率均无统计学差异(P>0.05)。结论:24针经会阴前列腺饱和穿刺活检方法显著提高PSA<20μg/L患者中前列腺癌的筛检阳性率,尤其是增加了前列腺尖部区域的肿瘤筛检阳性率,而并未增加相关并发症。     

直肠超声引导经会阴模版12+X针前列腺穿刺活检术临床研究

目的:评价直肠超声引导下经会阴模版12+X针前列腺穿刺活检术的临床价值和安全性。方法:2009年9月~2014年5月,对临床怀疑为前列腺癌的1 300例患者行直肠超声引导下经会阴模板前列腺穿刺活检术。1 300例患者平均年龄70.5岁,穿刺前均行血清PSA监测(不少于2次)、前列腺直肠指诊、经直肠前列腺超声及前列腺磁共振平扫加动态增强。所有患者取截石位,1%利多卡因注射液10~20ml会阴皮下及前列腺尖部局部浸润麻醉973例,骶管阻滞麻醉75例,硬膜外麻醉252例。共937例采用12+X针穿刺,363例采用常规12针穿刺。结果:所有患者均顺利完成操作,活检针数12~24针,平均14.5针;活检时间15~30 min,平均20.4min。术后发生一过性血尿201例,会阴部血肿14例,尿潴留21例,发热5例。穿刺病理结果:前列腺癌540例(41.5%),其中腺癌527例,其他类型肿瘤13例;前列腺上皮内瘤(PIN)57例(4.4%);前列腺增生及各类前列腺炎703例(54.1%)。T-PSA4μg/L、4~10μg/L、10~20μg/L及20μg/L组的穿刺阳性率分别为:13.1%、17.1%、31.9%、73.8%。TPSA 4~10μg/L组(灰区)293例患者分别以F/T PSA和PSAD分组,F/T≥0.16和0.16组的穿刺阳性率分别为12.0%、18.8%,PSAD≥0.15和0.15组的穿刺阳性率分别为9.8%、21.5%。直肠指诊异常、经直肠超声异常及前列腺MRI异常患者的穿刺阳性率分别为:24.0%、30.1%、59.2%。12+X针组穿刺阳性率为47.2%,12针组为34.5%。结论:直肠超声引导下经会阴12+X针前列腺穿刺活检术阳性率高,并发症少,是诊断前列腺癌的理想方法。     

Indication of repeat prostatic biopsy following previous negative findings

BACKGROUND: Many men with clinically suspicious findings would not be diagnosed to have prostate cancer. Establishing criteria for indicating repeat biopsy is imperative for early detection of prostate cancer. METHODS: Eighty-one patients underwent repeat prostatic biopsies under sonographic guidance at Kitasato University Hospital between March 1992 and October 1996. Clinicopathological parameters such as age, prostate specific antigen (PSA), PSA adjusted for transition zone volume (PSAT), PSA density (PSAD), PSA velocity, transition zone volume, prostatic volume, rectal findings, ultrasound findings and initial biopsy histology were compared with the results of repeat biopsy for searching for possible predictors of positive biopsy. RESULTS: Cancer was confirmed in 14 patients (17.3%), 10 patients by the second biopsy (15.4%, 10/65) and 4 patients by the third biopsy (28.6%, 4/14). No cancer was found at the 4th or more biopsies. Twelve (85.7%) of these patients had prostatic volume less than 40 cm3. Univariate analysis indicated PSAT, PSAD, transition zone volume and prostatic volume to be more frequent in men with positive biopsies (p < 0.05). But multivariate logistic regression analysis failed to identify any significant predictors of positive results in repeat biopsies. CONCLUSIONS: No clinicopathological parameters could reliably predict repeat biopsy findings. One or 2 additional sets of biopsies is recommended based on clinical judgement (symptoms, life expectancy, small glands < or = 40 cm3 etc.) for the purpose of early detection of prostate cancer in patients with previously negative biopsy but still with suspicious findings in consideration of approximately 20% false negative rates by the initial biopsy.     

Repeat biopsy strategy in patients with atypical small acinar proliferation or high grade prostatic intraepithelial neoplasia on initial prostate needle biopsy

PURPOSE: Isolated high grade prostatic intraepithelial neoplasia and/or atypical small acinar proliferation on prostate biopsy increases the risk of identifying cancer on repeat biopsy. We report the results of repeat prostate biopsy for high grade prostatic intraepithelial neoplasia and/or atypical small acinar proliferation, and propose an optimal repeat biopsy strategy. MATERIALS AND METHODS: Of 1,391 men who underwent standard systematic sextant biopsy of the prostate 137 (9.8%) had isolated high grade prostatic intraepithelial neoplasia or atypical small acinar proliferation, including 100 who underwent repeat prostate biopsy within 12 months of the initial biopsy. RESULTS: Adenocarcinoma was detected in 47 of the 100 patients who underwent repeat biopsy. The initial biopsy site of high grade prostatic intraepithelial neoplasia and/or atypical small acinar proliferation matched the sextant location of cancer on repeat biopsy in 22 cases (47%). Repeat biopsy directed only to the high grade prostatic intraepithelial neoplasia and/or atypical small acinar proliferation site on initial biopsy would have missed 53% of cancer cases. In 12 of the 47 men (26%) cancer was limited to the side of the prostate contralateral to the side of high grade prostatic intraepithelial neoplasia and/or atypical small acinar proliferation. Of the 31 patients with cancer in whom the transition zone was sampled cancer was limited to the transition zone in 4 (13%) and evident at other biopsy sites in 13 (42%). The only significant predictor of positive repeat biopsy was mean prostate specific antigen velocity plus or minus standard error (1.37 +/- 1.4 versus 0.52 +/- 0.8 ng./ml. per year, p <0.001). CONCLUSIONS: Patients with isolated high grade prostatic intraepithelial neoplasia and/or atypical small acinar proliferation on prostate biopsy are at 47% risk for cancer on repeat biopsy. The optimal repeat biopsy strategy in this setting should include bilateral biopsies of the standard sextant locations. We also strongly recommend that transition zone sampling should be considered.     

Systematic prostate biopsy before transurethral resection of the prostate

PURPOSE: With the aim of evaluating the clinical significance of systematic prostate biopsy before transurethral resection of the prostate (TUR-P), clinical data were reviewed retrospectively in patients who had underwent prostate biopsy prior to scheduled TUR-P. PATIENTS AND METHODS: Between July, 1994 and June, 2000, TUR-P was scheduled in a total number of 456 patients with clinically diagnosed benign prostatic hyperplasia (BPH). RESULTS: In 218 (47.8%) out of 456 cases, prostatic biopsy was conducted prior to TUR-P due to abnormally elevated serum prostate specific antigen (PSA) levels of 4.0 ng/ml or more, revealing only 22 (10.1%) cases of prostatic cancer. Between these 22 cases with biopsy proven prostatic cancer and 189 cases with BPH confirmed both by biopsy and following TUR-P, statistically significant differences were noted in age (p < 0.05), prostate volume (p < 0.0001) and PSA density (p < 0.01). CONCLUSION: Considering the low positive rate of preoperative prostatic biopsy, it might be suggested that a considerable number of biopsy could be avoided in patients with clinically diagnosed BPH. Based on the results obtained from this study, prostatic biopsy might be unnecessary before TUR-P for those with prostate volume greater than 60 ml or PSA density less than 0.15.     

Elevated serum prostate specific antigen levels in conjunction with an initial prostatic biopsy negative for carcinoma: who should undergo a repeat biopsy?

OBJECTIVE: To determine the outcome of repeated prostatic biopsies in men attending with suspected prostate cancer but an initial negative biopsy. PATIENTS AND METHODS: Patients who had undergone two or more transrectal ultrasonography (TRUS)-guided prostate biopsies were identified from the Hospital Information Support System database. Indications for TRUS were a raised prostate-specific antigen (PSA) level (>4.0 ng/mL), with or without an abnormal digital rectal examination (DRE). Sextant prostate biopsies plus biopsies of any suspicious hypoechoic area or area of DRE abnormality were obtained for histology. Forty-eight patients underwent repeat TRUS-guided prostatic biopsies (mean age 67.5, sd 7. 25, range 53-82 years). RESULTS: The mean (sd, median, range) PSA level was 16.9 (13.5, 11.6, 5.2-61.8) ng/mL. Fifteen patients (31%) had carcinoma on repeat biopsy, 11 after the second and four after a third biopsy. The positive repeat biopsy rate was 24% where the PSA level was 4.0-9.9 ng/mL, 33% if the level was 10.0-19.9 ng/mL and 39% if it was >/=20.0 ng/mL. There was no significant difference in age or initial PSA concentration between those men with positive and those with negative repeat biopsies. However, patients with cancer had significantly higher PSA levels before repeat biopsy than at first biopsy (P=0.0043) and had greater PSA velocities than had patients with no diagnosis of cancer (P=0.0067). CONCLUSION: Where sufficient clinical suspicion exists, despite an initial negative biopsy, repeat TRUS-guided prostate biopsies should be carried out to exclude carcinoma of the prostate.     

Strategy for repeat biopsy in patients with high grade prostatic intraepithelial neoplasia

PURPOSE: The finding of high grade prostatic intraepithelial neoplasia in a biopsy specimen without prostate cancer warrants repeat biopsy because of the risk of concurrent cancer. However, to our knowledge the optimal repeat biopsy technique has not yet been defined. We determined the optimal subsequent biopsy strategy for detecting concurrent cancer in patients diagnosed with high grade prostatic intraepithelial neoplasia. MATERIALS AND METHODS: Of 63 men with isolated high grade prostatic intraepithelial neoplasia on initial biopsy 45 underwent repeat biopsy within 1 year. Certain biopsy patterns were used for repeat biopsy, including only the neoplasia site in 8 men, sextant in 12, sextant plus bilateral transition zone in 13 and 11 core multisite directed (sextant, bilateral transition zone, bilateral anterior horn of the peripheral zone and midline peripheral zone) in 12. We compared the location of high grade disease on the initial biopsy with the cancer site on repeat biopsy. RESULTS: Repeat biopsy revealed cancer in 10 of the 45 men (22%), and the sites of high grade prostatic intraepithelial neoplasia and cancer correlated in 6. Cancer was detected at the sextant locations in 9 men. Of the 15 cores positive for cancer 8 were at the original high grade neoplasia site, 6 at a random sextant biopsy site and 1 in the transition zone. High grade disease was discovered bilaterally in 1 man, while prostatic intraepithelial neoplasia and cancer were detected on the same side in the remaining 9. CONCLUSIONS: The optimal repeat biopsy strategy for patients with high grade prostatic intraepithelial neoplasia has not yet been determined but at a minimum it should include targeting the area of known high grade disease and the ipsilateral sextants.     

Repeat biopsy of the suspicious prostate cancer: especially the usefulness of MRI

Among patients with negative initial biopsies of the prostate, 51 patients underwent total 59 repeat biopsies at the Department of Urology of Ikeda Municipal Hospital between January 1998 and April 2004. Overall 26 patients (44.1%) were confirmed to have cancer, 22 patients by second repeat biopsy (22/51), four patients by third biopsy (4/7) and none by fourth biopsy (0/1). Clinical parameters (age, PSA, PSA density, PSA velocity) were analyzed for the possibility to predict the pathological outcome. Significant differences between the positive biopsy group and the negative biopsy group were obtained in age, PSA level and prostatic volume. Of the diagnostic evaluations including palpation and imaging studies (DRE, TRUS, MRI), the most powerful predictor for prostate cancer seemed to be the MRI findings, especially in the cases of short-interval repeat biopsy. Biopsies directed at the positive lesion on MRI in addition to systematic prostate biopsies should be useful.     

902例超声引导下经直肠前列腺穿刺的并发症分析及处理

目的探讨经直肠前列腺穿刺并发症的发生及防治措施。 方法回顾性分析中山大学附属第一医院泌尿外科2012年1月至2016年12月共902例经直肠前列腺穿刺的患者病例资料,分析患者术后并发症发生情况及处理方法。 结果902例穿刺患者中,发生血尿者270例（29.93％）;发生血便者155例（17.18％）,其中直肠出血者19例（占血便的12.26％）;继发感染者46例（5.11％）,其中急性附睾炎者4例（占感染的8.70％）,感染者中有1例发生穿刺术后败血症导致横纹肌溶解及急性肾损伤;发生血管迷走神经反射者7例（0.78％）。 结论经直肠前列腺穿刺术技术简单易行、创伤少,但仍有发生并发症的可能,穿刺前的充分合理准备及术后预防均十分重要。     

A single injection of lidocaine as local anesthesia for ultrasound guided needle biopsy of the prostate.

PURPOSE: We evaluated the effectiveness of a single injection of lidocaine on patient tolerance of multiple needle biopsies of the prostate. MATERIALS AND METHODS: In 100 consecutive group 1 patients local anesthesia was achieved by a single bolus injection of 10 ml. lidocaine and multiple prostatic needle biopsies was performed under ultrasound guidance. At the end of the procedure patients were asked to complete a questionnaire regarding the level of pain. Answers were compared with those of 100 group 2 patients who underwent prostatic biopsy before the introduction of local anesthesia. RESULTS: Of the group 1 patients 93% had only slight discomfort during the procedure and 7% required a further 1 cc bolus of lidocaine. In 55% of group 2 patients the level of pain during the procedure was significant but bearable, in 35% it was considered unbearable and in 10% sedation with midazolam was necessary. There was no significant difference in complications in the 2 groups. CONCLUSIONS: A single injection of local anesthesia for prostatic biopsy proved to be efficient, well tolerated by patients and effective for decreasing the pain associated with the procedure.     

Determination of the percentage of free prostate-specific antigen helps to avoid unnecessary biopsies in men with normal rectal examinations and total prostate-specific antigen of 4-10 ng/ml

OBJECTIVE: To assess the usefulness of measuring the percentage of free prostate-specific antigen (PSA) in serum to reduce the number of prostate biopsies in men with serum PSA levels between 4 and 10 ng/ml and benign prostate examinations. MATERIALS AND METHODS: The percentage of free PSA (Immulite((R))) in serum was analyzed prospectively in 180 men with benign digital rectal examinations and total PSA serum levels of between 4 and 10 ng/ml. All patients underwent ultrasound-guided sextant prostatic biopsies. Sensitivity, specificity and positive and negative predictive values were calculated as well as the percent of patients in which biopsies could have been avoided for various cutoff values of the percentage of free PSA as an indicator for biopsy. Influence of age in the determination of cut points was evaluated. RESULTS: Cancer was detected in 22.2% (40/180) of the patients. Mean percentage of free PSA was 13.4% in patients with cancer and 18.9% in patients with benign prostatic hyperplasia (p = 0.001). Using a percentage of free PSA cutoff of 22% or less as a criterion for performing prostatic biopsy would have detected 95% of cancers, avoided 25% of benign biopsies and yielded a positive predictive value of 29% in patients who underwent biopsy. Mean percent of free PSA values increased as mean subject age increased, influencing the calculation of cut points, sensitivity and specificity. Leaving the cut point constant across all age groups will oblige older patients to undergo an increased number of unnecessary biopsies, although allowing for higher sensitivity in younger men. CONCLUSIONS: Measurement of the percentage of free serum PSA improves specificity of prostate cancer detection in patients with elevated total serum PSA levels and benign prostate examinations. Subject age seemed to influence the determination of optimal cut points.     

Should high-grade prostatic intraepithelial neoplasia change our approach to infravesical obstruction?

OBJECTIVES: To investigate whether coexistence of high-grade prostatic intraepithelial neoplasia (HPIN) should change our therapeutic approach to infravesical obstruction. MATERIAL AND METHODS: Of 505 patients who underwent sextant transrectal ultrasonography (TRUS)-guided prostate biopsy, 65 (12.8%) had HPIN and 29 of them underwent prostatectomy (23 transurethral resection of prostate (TURP), 6 open) due to obstructive urinary symptoms. Patients without carcinoma were followed up with semiannual prostate-specific antigen (PSA) and digital rectal examination. After a follow-up of 24.8 +/- 11.0 months, 19 of 29 patients who accepted our call had another sextant biopsy. RESULTS: Mean age and initial mean PSA values of 29 patients were 67.6 +/- 6.7 years and 9.26 +/- 5.91 ng/ml, respectively. The final pathological evaluation of the surgical specimens revealed 2 prostatic adenocarcinomas both in the TURP group. The remaining 27 (93.2%) patients were found to have benign prostatic hyperplasia (BPH) and their serum PSA levels declined from 9.26 +/- 5.91 to 4.59 +/- 2.0 ng/ml 3 months after prostatectomy. Of the 19 patients who had another biopsy with a mean PSA value of 4.06 +/- 4.61 ng/ml, 15 and 4 of them had BPH and HPIN respectively. CONCLUSIONS: Our preliminary data indicate that the presence of HPIN on TRUS-guided biopsies is not a factor to delay an indicated surgical intervention for infravesical obstruction.